Severe Myocardial Impairment and Chamber Dysfunction in Preterm Preeclampsia

Melchiorre, K.; Sutherland, George R.; Watt-Coote, Ingrid; Liberati, Marco; Thilaganathan, B.

doi:10.3109/10641955.2012.697951

Cited by 108 publications

(99 citation statements)

References 35 publications

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“…24,25 We and others have previously identified compromised cardiac function in pregnancy complicated by preeclampsia both at the time of diagnosis and in the early preclinical phase at midgestation. 15,[26][27][28] The cardiovascular findings of diastolic dysfunction and myocardial impairment seen in normal pregnancy at term in this study are strikingly similar to those previously observed in preeclampsia. 15,[26][27][28][29] It is possible that if these normal pregnancies had not been truncated by term birth, they may have gone on to develop preeclampsia-a time-dependent disorder that is eliminated by such intervention bias.…”

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confidence: 78%

Maternal Cardiovascular Function in Normal Pregnancy

et al. 2016

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Abstract-The aim of this study was to investigate cardiac functional status in pregnancy using a comprehensive approach taking into account the simultaneous changes in loading and geometry, as well as maternal age and anthropometric indices. This was a prospective cross-sectional study of 559 nulliparous pregnant women assessed at 4 time points during pregnancy and at 1 year postpartum. All women underwent conventional echocardiography and tissue Doppler velocities and strain rate analysis at multiple cardiac sites. Mean arterial pressure and total vascular resistance index significantly decreased (both P<0.001) during the first 2 trimesters of pregnancy and increased thereafter. Stroke volume index and cardiac index showed the opposite trend compared with mean arterial pressure and total vascular resistance index (both P<0.05). Myocardial and ventricular function were significantly enhanced in the first 2 trimesters but progressively declined thereafter. By the end of pregnancy, significant chamber diastolic dysfunction and impaired myocardial relaxation was evident in 17.9% and 28.4% of women, respectively, whereas myocardial contractility was preserved. There was full recovery of cardiac function at 1 year postpartum. Cardiovascular changes during pregnancy are thought to represent a physiological adaptation to volume overload. The findings of a drop in stroke volume index, impaired myocardial relaxation with diastolic dysfunction, and a tendency toward eccentric remodeling in a significant proportion of cases at term are suggestive of cardiovascular maladaptation to the volume-overloaded state in some apparently normal pregnancies. These unexpected cardiovascular findings have important implications for the management of both normal and pathological pregnancy states. Melchiorre et al Cardiac Function and Geometry in Pregnancy 755changes in maternal loading conditions, cardiac geometry, as well as age and anthropometric indices. MethodsThis was a prospective cross-sectional study performed over a 5-year period from June 2008 to February 2013. Healthy nulliparous women with singleton viable pregnancy were recruited consecutively from the routine antenatal clinic at St George's Hospital, University of London. The local institutional review committee approved the study, and all participants provided written informed consent. Women who subsequently developed adverse maternal complications, such as diabetes mellitus, preeclampsia, peripartum cardiomyopathy, pregnancy complication, or any other medical comorbidity, were excluded from the analysis. Women were recruited at 4 time points during pregnancy (11-14, 20-23, 28-32, and 37-39 weeks' gestation) and at 1 year postpartum after pregnancy care in our institution. A group of 50 nonpregnant healthy volunteer nulliparous women matched for age was also assessed to derive baseline echocardiographic values. All groups were matched for ethnicity and maternal age. To ensure that we recruited optimally healthy women, we also excluded women with a prepregnancy body mass...

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confidence: 78%

Maternal Cardiovascular Function in Normal Pregnancy

et al. 2016

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“…Bamfo et al, found that longitudinal left ventricular systolic function tissue Doppler indices were reduced in preeclampsia and concluded that myocardial contractility was impaired in this condition [12]. Results of Melchiorre et al, showed that preeclampsia is associated with biventricular diastolic dysfunction, altered geometry and widespread myocardial impairment and only preterm but not term preeclampsia is characterized by biventricular systolic dysfunction [13]. However, none of our patients had impaired left ventricular ejection fraction.…”

Section: Discussionmentioning

confidence: 91%

Maternal Cardiac Diastolic Dysfunction by Doppler Echocardiography in Women with Preeclampsia

Muthyala¹

2016

JCDR

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“…Importantly, preeclampsia involves multisystem dysfunction. There is evidence of structural and functional cardiac impairments in women during pregnancies complicated by preeclampsia 12, 13, 14. Biomarkers of cardiac remodeling are also elevated during these pregnancies 15…”

Section: Pathophysiology and Risk Factorsmentioning

confidence: 99%